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PUBLIC

Kenya School of Revenue Administration


ISO 9001:2015 CERTIFIED (KESRA)
WORKSHOP REGISTRATION FORM

COMPANY DETAILS
Name of Organization/
Individual
Sector and Personal Email
address
ID/ Passport Number
Building …………………………………
Physical Address Street & Floor………………………………...

Postal address& Code


Landline
Telephone Numbers Mobile
Name & Email Address of
the Director/ Manager
Name & Email Address of
HR Director/Manager
Training Name
Date
Your organization Pin No
PLEASE PROVIDE NAMES OF YOUR STAFF YOU ARE NOMINATING TO ATTEND THE
WORKSHOP
Name Title/ Position Email Mobile No

PAYMENT DETAILS
In favour of the
Kenya School of Revenue Administration

Account Name: Kenya school of Revenue PAY VIA MPESA


Administration Revenue Collection A/C Lipa na Mpesa
Account No: 01136743362900
Bank name: Co-operative bank account Paybill No: 833613
Branch: Co-operative House Account Name: ORGANIZATION
Swift code: KCOOKENAXXX NAME/INDIVIDUAL NAME ID/PASSPORT NO
Bank Code: 11002
NB: Indicate the name of the organisation and the course
on the deposit slips.
Name of Authorizing Manager Signature and Date

Cheque No Amount

REGISTRATION AND BOOKING

CONTACT : Johnson, Judy or Collins


KESRA NAIROBI : Training Section
Tel: 0709752727/0725781510.
Email : kesratraining@kra.go.ke

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